Herd Chiropractic Clinic, P.C. v. State Farm Mutual Automobile Insurance
29 A.3d 19
| Pa. Super. Ct. | 2011Background
- Mitten sustained injuries in a car accident and received chiropractic care at Herd Chiropractic Clinic, P.C.
- State Farm submitted Herd's chiropractic bills to a peer review organization (PRO) under MVFRL § 1797 to challenge reasonableness and necessity.
- PRO determined the treatments were not medically necessary or reasonable, leading State Farm to refuse payment for certain treatments.
- Herd filed suit for unpaid medical expenses, attorneys' fees, and treble damages; trial court awarded unpaid expenses but denied treble damages and fees.
- Upon reconsideration, the trial court awarded Herd attorneys' fees of $27,047.50; State Farm appealed.
- The court held that following the peer review process does not preclude an award of attorneys' fees if the court later determines the treatment was medically necessary.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether a court may award attorneys' fees despite following Act 6's peer review | Herd argues fees are proper if court finds care necessary | State Farm contends Act 6 precludes fees when peer review is followed | Fees may be awarded if court finds medically necessary care, even after peer review |
| Whether Barnum controls whether fees are awarded when peer review is followed | Barnum prohibits bad-faith treble damages after peer review but not fees | Barnum governs treble damages but not attorney's fees | Barnum is not dispositive for attorney's fees; fees may be awarded here |
| Whether trial court properly limited testimony from former Insurance Commissioner Foster | Foster's regulatory history and intent are relevant to Act 6 | Testimony should focus on wanton conduct; Foster shouldn't testify beyond that | State Farm waived this claim by failing to object to the limitation |
Key Cases Cited
- Terminato v. Pennsylvania Nat. Ins. Co., 538 Pa. 60 (Pa. 1994) (peer review process is a mechanism to assess reasonableness/necessity of treatment)
- Barnum v. State Farm, 430 Pa. Super. 488 (Pa. Super. 1993) (insurer cannot be liable for treble damages if peer review is followed)
- Barnum v. State Farm, 635 A.2d 155 (Pa. Super. 1993) (reversed on other grounds; supports bad-faith damages discussion)
- Kuropatwa v. State Farm Ins. Co., 721 A.2d 1067 (Pa. 1998) (provisions of 1797(b)(1)–(6) and PRO review framework)
- Kvaerner Metals Division of Kvaerner U.S., Inc. v. Commercial Union Ins. Co., 908 A.2d 888 (Pa. 2006) (plenary review on questions of law)
- Andaloro v. Armstrong World Industries, Inc., 799 A.2d 71 (Pa. Super. 2002) (summary judgment and contract/claims standards guidance)
- Dilliplaine v. Lehigh Valley Trust Co., 322 A.2d 114 (Pa. 1974) (issues not raised at trial waived on appeal)
- Mitten v. State Farm, not provided (not provided) (citation provided for context of MVFRL Act 6 framework)